I plan to spend the month of May 2019 at Kamuzu Central Hospital (KCH), the referral hospital in central Malawi. I will be working mainly in the Emergency Zone (EZ), which is the ward of the hospital with the acutely ill children that need the most rapid interventions. The month of May is during malaria season, which is the season with the highest volume of the most critical children needing care. During malaria season in the EZ, children are often 6 to a bed with their caregivers sitting on the floor next to them. Approximately 2-4 comatose children with cerebral malaria are brought in seizing each day, and even more children with severe malaria with anemia die waiting for blood transfusions. As a senior pediatric emergency medicine fellow physician, I have the skills needed to take care of the critically ill children that are admitted to the EZ.
Malawi is an African nation of 16.8 million with a high burden of malaria and HIV. Malawi has 3 million children <5 years and an under-5 mortality rate of 68/1000. The current KCH inpatient mortality rate is 4% with 25,000 yearly pediatric admissions and >80% under-5 years, resulting in 800 under-5 deaths per year. The largest proportion of admissions and deaths occur during malaria season. This large clinical burden is met with a severely understaffed pediatric department, and thus extra staffing is needed especially during this time. Thus, the children of Malawi will benefit from my trip at a time when they need extra hands to care for them the most.
First and foremost, I hope to help save the lives of children while I am there. I have worked at KCH in the EZ before and while there for 1 month ran 13 code resuscitations, did 36 lumbar punctures, placed 2 interosseous lines, performed a needle decompression of the chest, and did countless ultrasounds. In addition, I supervise and teach medical officers and interns while there. Thus, I have the opportunity to leave behind emergency medicine skills to the learners at KCH. Further, I am doing baseline research on severe anemia in children admitted to the EZ, and hope to use this research to brainstorm and propose care process models to improve the care of these children by getting them blood transfusions faster.
During my month working at Kamuzu Central Hospital in Lilongwe, Malawi I saw many pediatric patients in the Emergency Zone. I help identify and resuscitate critically ill children with conditions ranging from hypovolemic shock due to gastroenteritis to severe anemia secondary to malaria to trauma. I am sedation trained and thus performed sedations for painful procedures. I performed and assisted local staff to perform ultrasound scans to assist in clinical decision making. I also performed procedures within my scope of training such as lumbar punctures and blood draws. I even administered medications and respiratory treatments, necessary for doctors to do due to severe staff shortages. I taught interns and medical students, which is one of my favorite things about working in Malawi. Overall, it was a very productive month and I can't wait to go back!